(PS9-C75) Factors Impacting past and Prospective Group Therapy Utilization Among Individuals with Suicidal Thoughts and Behaviors

Suicide is the 11^th leading cause of death in the U.S. (CDC, 2022). Connecting individuals with suicidal thoughts and behaviors (STBs) to treatment is challenging; over 50% of adults with past year STBs do not receive care, often due to financial and provider access constraints (SAMHSA, 2015). Group therapy (GT) may reduce these barriers as it is more time and cost efficient than individual therapy (Rosendahl et al., 2021). Little is known about acceptability of GT among those at STB risk, though preliminary work is promising (Hom et al., 2018). The current study aimed to examine factors impacting GT engagement among individuals with past 5-year STBs. More specifically, we examined GT engagement, likelihood of future GT engagement, the influence of demographic factors, factors that may impact provider access (and thus likelihood of GT referral), and treatment history on prior GT attendance.

                Participants were 978 U.S. adults (Mage=39.04, SD=14.29) recruited from Prime Panels; 62.4% identified as women, 75.4% as White, and 15% as Hispanic. Two decision tree analyses were conducted to predict 1) prior GT attendance (yes / no) and 2) self-reported likelihood of future GT attendance (1-5 Likert scale). Covariates in both models included: age, gender, race, ethnicity, education level, income, health insurance, region of residence, community size, prior residential treatment, and prior psychiatric hospitalization; prior outpatient GT attendance was included in the second tree. All splits were significant at p< .01.

The tree predicting prior GT utilization resulted in five nodes. The primary splitting variable was education, followed by income and community size. Individuals with a GED and annual income of $10-20k were most likely to have attended GT (8% of the sample). Next were those making $10-20k with an education of technical school or higher living in urban areas (3%), followed by those in a rural area (4%). Those who reported a high school education or less were least likely (48%), followed by those with a GED or higher making more than $20k (35%).

The second tree examined self-reported likelihood to attend GT. The primary splitting variable was prior GT attendance, followed by income and community population. Those with a history of GT reported higher likelihood of engaging in future GT. Among these individuals, those with income of $70k or more living in urban areas reported the highest likelihood of future GT attendance (9% of sample), followed by their peers in rural areas (3%), and then individuals with income less than $70k (26%). Among those without prior GT, those with income less than $70k were least likely to attend GT (41%), followed by those with income of $70k or more (21%).  

Results indicate that lower income individuals were more likely to attend GT than their higher income peers; however, individuals with lower education were less likely to attend GT. Prior GT attendance was the main facilitator of future GT attendance, but in contrast to prior GT attendance, lower income individuals with past GT experience reported lower willingness to engage in future GT. Identifying factors contributing to this discrepancy may increase service utilization and potentially inform recruitment strategies for first-time group members.